Fitness improvements amongst children in one Alberta First Nation after eight years of particpatory research and Community commitment
Fitness Improvements among childrenin one Alberta First NationBRAID-KidsBRAID Prevention of Obesity and Diabetes inChildren and Families (BRAID-Kids)Paulette Campiou, Diabetes Coordinator, Driftpile First NationDr. Ellen Toth, Principal Investigator, University of Alberta
BRAID = Believing we can Reduce Aboriginal Incidence of DiabetesORIGINAL BRAID STUDY (2003-2006)Collaboration between Driftpile and the University of Alberta.Screened the population of Driftpile for undiagnosed diabetes (includingchildren)Screening results in 89 children and adolescents:Community wanted to work on PREVENTION, involving children and theirfamiliesPre-diabetes 27%Probable diabetes 1.2%Overweight 22%Obese 44%
Setting:DRIFTPILE CREE NATION is 350kms northwest of Edmonton,Alberta, on the shores of LesserSlave LakeDriftpile has approximately 1600Band Members, of whom about 850live on reserve land.Driftpile is home to approximately200 children and adolescents ages5-17.
BRAID-Kids STUDY DESIGNBRAID-Kids was based on the Kahnawake SchoolsDiabetes Prevention Program (KSDPP) and the SandyLake diabetes prevention program, and used educationalmaterials and assessment tools developed by theseprograms.However, BRAID-Kids planned to have an improvedstudy design – Cree Pride – based on Pima Pride: a “de-colonizing” project where exposure to Pima tradition andculture improved diabetes control (Narayan, 1998)
BRAID-KidsHypothesis: Decolonization may enable First Nations families to avoidbehaviors that contribute to obesity and diabetes risk.Primary Outcome: assess physical activity and dietary choices amongstchildren, by:Measuring clinical, anthropometric and fitness outcomes ofparticipating children near the beginning and end of each school year;Administering a food frequency and physical activity questionnaireImplementing an in-classroom diabetes prevention curriculum;Implementing a tradition-based “Cree Pride” program aimed atparents/guardians/families.
Mihtatakaw Sipiy (ELEMENTARY) School,DRIFTPILE FIRST NATIONBuilt in the shape of an eagle feather
RESULTS:Recruitment: 89 children and their families were recruited, but thistook 2 yearsFitness assessments and risk assessments were conducted nearthe beginning and end of the school year.BRAID-Kids Project Dietitian visited the school and the communityregularlyThe Cree Pride intervention component was developed as 6-10sessions but it was not implemented, due to competing activitiesand programs being carried out by the community, the recreationdepartment, the health center and school;.
Baseline clinical, anthropometric for all children measured by BRAID-Kids, N=89MEASUREMENT RESULTSGender, % female 42 (47.2%)Mean age, years 8.2 (range: 4-15)Fasting glucometer blood glucose, N=59Mean (mmol/L) 5.4 (range: 4.3-7.8)“Possible” diabetesa, # of children (%) 1 (1.7%)“Possible” pre-diabetesb, # of children (%) 7 (11.9%)Body Mass Index (BMI), N=87:≥85th-<95th, overweightc, # of children (%) 18 (20.7%)≥95th, obesityc, # of children (%) 43 (49.4%)Central adiposityd, N=88, # of children (%) 74 (84.1%)Hypertensione, N=60, # of children (%) 14 (23.3%)a. fasting blood glucose ≥7.0 mmol/L; b. fasting blood glucose 6.1-6.9 mmol/L; c. CDC percentile reference for age and gender; d. NHANESIII: central adiposity= waist circumference ≥85th percentile for age and gender; e. CDC percentile reference for age and gender, hypertension: ≥95th percentile;
Fitness Testing: 20m Multi-stage Shuttle Run “beep test” (Leger, 1984, 1988) Measures “maximal oxygen uptake”, which indicates aerobic fitness..
Fitness percentiles for age and gender, N=86aGender (% female) 37 (43.0%)Mean Age (years) 9Fitness: percentile for age and genderb, N = 86# of children < 5th percentile (percent) 58 (67.4%)# of children 5th to <10th percentile (percent) 8 (9.3%)# of children 10th to <20th percentile (percent) 9 (10.5%)# of children 20th to <30th percentile (percent) 5 (5.8%)# of children 30th to <40th percentile (percent) 1 (1.2%)# of children 40th to < 50th percentile (percent) 3 (3.5%)# of children 50th to <60th percentile (percent) 2 (2.3%)# of children below 20th percentilec(percent) 75 (87.2%)Baseline Fitness results for children who underwent fitnesstesting by BRAID-Kidsa. children under the age of 6 were excluded, per Leger reference (Leger, 1984)b. (Leger, 1984)c. relative fitness = >20th percentile (Downs, 2006)
RESULTS AFTER ONE YEARWe looked at changes for children who had repeat testsundertaken after a 1 year interval:Significant improvements in fitness scores (in age-and-gender percentile rank and VO2 Max)No differences in glucose, weight, waist or BP except for anincrease in the % of children with diastolic (but not systolic)hypertension*BASELINE RESULTSBaseline results were once again consistent with our very highrates of overweight and obesity and very low levels of fitnessreported for some First Nations communities.
Mean improvements in age-and-gender percentiles for childrentested at 1 year intervals (Leger, 1984), N=19* p < 0.01 from paired t-test
Mean VO2 Max values for children tested at 1 yearintervals (n = 24)* p < 0.01 from paired t-test
INTERPRETATIONObserved improvements in fitness are likely not a direct result of BRAID-Kids alone:A new physical education program with a specific gym teacher atthe school was very helpfulBecause of regular “beep tests” in gym class, children becamepracticed at test proceduresIncreased surveillance communicated a focus on fitness tochildren and their families.Since many Band Councils control their community’s educationbudget and policies, our results may be helpful information forLeadership decision-making.
IN SUMMARYPositive things are happening:Some families report having changed their eatinghabits.BRAID-Kids Project Dietitian visiting Driftpile regularly.Full-time school gym teacher.numerous community efforts at promoting preventionand healthy living; and,CREE PRIDE
Acknowledgements:Lawson FoundationAlberta Center for Child Family and Community ResearchChief Rose LaboucanHealth Director Florence WillierResearch assistants:Trina ScottTessirae SasakamoosePriscilla LalondeU of A support: Kelli Ralph CampbellDietitian: Kari Quinn